ORIGINAL_ARTICLEMandibular Fractures and Associated Factors at a Tertiary Care HospitalObjectives
The aim of this study was to evaluate the distribution, etiology and type of mandibular fractures in subjects referred to our institution.
Methods
A retrospective study of 689 subjects, during the period from May 2010 to September 2013 with mandibular fractures was conducted. Information on age, gender, mechanism of injury and sites of trauma was obtained from the trauma registry. Data were tabulated and analyzed statistically.
Results
A total of 653 subjects had mandibular fractures, out of which 574 were males. The mean age of the participants was 31.54 ± 13.07. The majority of the subjects were between 21-40 years of age, in both males (61.7%) and females (54.4%). The major cause of fractures was road traffic accidents (87.4%) followed by fall (6.9%) and assault (4%), with the least frequent being gunshot injuries (0.3%). Almost half of the patients had parasymphysis fractures (50.2%), followed by angle (24.3%), condyle (20.4%), ramus (2.3%) and coronoid (2%). A total of 115 patients had bilateral fractures out of which 29 had parasymphysis, 12 had body fractures and 74 had bilateral condylar fractures. Double mandibular fractures were reported in 193 subjects; out of which 151 subjects had double contralateral and 42 had double unilateral fractures. Triple unilateral fracture was reported in only one subject. A total of 338 subjects had multiple fractures among the study population.
Conclusions
Mandibular fractures can be complicated and demanding, and have a compelling impact on patients’ quality of life. Our study reported that parasymphysis was the most common region involved in mandible fractures.http://archtrauma.kaums.ac.ir/article_62275_cdd5494fb90671271dd260c9b67cadca.pdf2016-09-01T11:23:202019-03-21T11:23:2010.5812/atr.30574EpidemiologyFracturesmandibleTraumaSrikanthGadicherlatrue1Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaDepartment of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaDepartment of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaAUTHORPremSasikumartrue2Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaDepartment of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaDepartment of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaAUTHORSatpal SinghGilltrue3Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaDepartment of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaDepartment of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaAUTHORManishBhaganiatrue4Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaDepartment of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaDepartment of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaAUTHORAbhay TaranathKamathtrue5Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaDepartment of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaDepartment of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaAUTHORKalyana ChakravarthyPentapatitrue6Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaDepartment of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaDepartment of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Karnataka, IndiaLEAD_AUTHORORIGINAL_ARTICLESpatial Factors Affecting the Frequency of Pedestrian Traffic Crashes: A Systematic ReviewContext
Considering the importance of pedestrian traffic crashes and the role of environmental factors in the frequency of crashes, this paper aimed to review the published evidence and synthesize the results of related studies for the associations between environmental factors and distribution of pedestrian-vehicular traffic crashes.
Evidence Acquisition
We searched all epidemiological studies from 1966 to 2015 in electronic databases. We found 2,828 studies. Only 15 observational studies out of these studies met the inclusion criteria of the study. The quality of the included studies was assessed using the strengthening the reporting of observational studies in epidemiology (STROBE) checklist.
Results
A review of the studies showed significant correlations between a large number of spatial variables including student population and the number of schools, population density, traffic volume, roadway density, socio-economic status, number of intersections, and the pedestrian volume and the dependent variable of the frequency of pedestrian traffic crashes. In the studies, some spatial factors that play an important role in determining the frequency of pedestrian traffic crashes, such as facilities for increasing the pedestrians’ safety were ignored.
Conclusions
It is proposed that the needed research be conducted at national and regional levels in coordination and cooperation with international organizations active in the field of traffic crashes in various parts of the world, especially in Asian, African and Latin American developing countries, where a greater proportion of pedestrian traffic crashes occur.http://archtrauma.kaums.ac.ir/article_62276_915a27e98635ba62ef77a43d92030959.pdf2016-09-01T11:23:202019-03-21T11:23:2010.5812/atr.30796pedestrianRoad Crashesspatial analysisSpatial FactorsSystematic reviewAliMoraditrue1Department of Epidemiology, Faculty of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, IR IranDepartment of Epidemiology, Faculty of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, IR IranDepartment of Epidemiology, Faculty of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, IR IranAUTHORHamidSooritrue2Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR IranSafety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR IranSafety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR IranLEAD_AUTHORAmirKavousitrue3School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, IR IranSchool of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, IR IranSchool of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, IR IranAUTHORFarshidEshghabaditrue4Department of Human Geography/Urban Planning, Faculty of Geography, University of Tehran, Tehran, IR IranDepartment of Human Geography/Urban Planning, Faculty of Geography, University of Tehran, Tehran, IR IranDepartment of Human Geography/Urban Planning, Faculty of Geography, University of Tehran, Tehran, IR IranAUTHOREnsiyehJamshiditrue5Community Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, IR IranCommunity Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, IR IranCommunity Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, IR IranAUTHORORIGINAL_ARTICLEProximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and ComplicationsContext
Fractures of proximal fifth metatarsal are one of the most common fractures of the foot.
Evidence Acquisition
A search of PubMed for studies on proximal fifth metatarsal fracture and Jones fracture focusing on the classification and management was performed. The reference list of the retrieved articles was searched for additional related studies.
Results
The vascular supply and soft tissue anatomy of the fifth metatarsal explains the increased risk of delayed union and non-union in fractures at the metaphyseal-diaphyseal junction. Lawrence and Botte classify proximal fifth metatarsal fractures according to their location: tuberosity avulsion fractures (zone 1), fractures at metaphyseal-diaphyseal junction extending into the fourth-fifth intermetatarsal joint (zone 2) and proximal diaphyseal fractures (zone 3). Zone 1 fractures are treated conservatively with functional immobilization and early mobilization with excellent outcome. For zone 2 and zone 3 fractures, acute forms can be treated conservatively but with a risk of delayed union time and time for return to function. Therefore, early surgical fixation with intramedullary screw is advised in athletic individuals. For cases presented with signs of delayed union and non-union, surgical treatment with or without bone grafting is recommended. Complications of these fractures and their management are discussed in this report.
Conclusions
Lawrence and Botte’s classification of proximal fifth metatarsal fractures is recommended by experts, due to its implication on prognosis and treatment strategy. Zone 1 fractures should be treated conservatively due to their excellent healing potential. Early operative treatment is advised for zone 2 and zone 3 fractures, especially in the athletic group. Complications of delayed union, non-union and refractures should be treated by revision fixation and bone grafting.http://archtrauma.kaums.ac.ir/article_62277_cc1884141201124c4b73b9b5bbbfe8d3.pdf2016-09-01T11:23:202019-03-21T11:23:2010.5812/atr.33298Metatarsal BonesFracturesBoneEvidence-based medicineClassificationAnatomyFracture fixationChi NokCheungtrue1Department of Orthopedics and Traumatology, North District Hospital, Hong Kong SAR, ChinaDepartment of Orthopedics and Traumatology, North District Hospital, Hong Kong SAR, ChinaDepartment of Orthopedics and Traumatology, North District Hospital, Hong Kong SAR, ChinaAUTHORTun HingLuitrue2Department of Orthopedics and Traumatology, North District Hospital, Hong Kong SAR, ChinaDepartment of Orthopedics and Traumatology, North District Hospital, Hong Kong SAR, ChinaDepartment of Orthopedics and Traumatology, North District Hospital, Hong Kong SAR, ChinaLEAD_AUTHORORIGINAL_ARTICLEHyperammonemia as a Marker of Subclinical Seizures After Traumatic Cardiac ArrestThis report details the presence of hyperammonemia in a patient who sustained cardiac arrest after a traumatic amputation. Serum ammonia levels may rise due to numerous etiologies; however, few reports detail its usefulness in diagnosing subclinical seizures. In this case, we successfully utilized persistently elevated serum ammonia levels as a marker of subclinical seizures in a patient who sustained traumatic cardiac arrest.http://archtrauma.kaums.ac.ir/article_62278_146e97a73769a1002d279a2d22710408.pdf2016-09-01T11:23:202019-03-21T11:23:2010.5812/atr.33361HyperammonemiaSeizureTraumatic Cardiac ArrestPatriciaAswanitrue1Department of Research, Staten Island University Hospital, New York, United StatesDepartment of Research, Staten Island University Hospital, New York, United StatesDepartment of Research, Staten Island University Hospital, New York, United StatesAUTHORMichaelKalinatrue2Department of Surgery, Staten Island University Hospital, New York, United StatesDepartment of Surgery, Staten Island University Hospital, New York, United StatesDepartment of Surgery, Staten Island University Hospital, New York, United StatesLEAD_AUTHORORIGINAL_ARTICLEEarly Prediction of Ongoing Hemorrhage in Severe Trauma: Presentation of the Existing Scoring SystemsEarly prediction of ongoing hemorrhage may reduce mortality via the earlier delivery of blood products, adequate orientation of the patient in a dedicated highly specialized and trained infrastructure, and by earlier correction of acute traumatic coagulopathy. We identified 14 scores or algorithms developed for the prediction of ongoing hemorrhage and the need for massive transfusion in severe trauma patients.http://archtrauma.kaums.ac.ir/article_62279_e95b22f2c0172ea372703fef7d56c9ba.pdf2016-09-01T11:23:202019-03-21T11:23:2010.5812/atr.33377transfusionhemorrhageWounds and InjuriesMartin LTonglettrue1Emergency Department, Liege University Hospital, Domaine du Sart Tilman, BelgiumEmergency Department, Liege University Hospital, Domaine du Sart Tilman, BelgiumEmergency Department, Liege University Hospital, Domaine du Sart Tilman, BelgiumLEAD_AUTHORORIGINAL_ARTICLEDeath as a Consequence of a Hip Fracture After a Fall; to Be Further Investigated?Although it is not often thought of, elderly abuse is a frequently occurring phenomenon. Especially when an older patient dies, maltreatment is low on the list of possible causes of death. There are, however, signs that may point in the direction of abuse. These can either be on the patient’s body, in the surroundings, or within the story as to how the patient died. Attention should be paid to these often subtle signs, and autopsies need to be performed more frequently to establish the exact cause of death.http://archtrauma.kaums.ac.ir/article_62280_7dd460ec11d5eac3c54b0f1907f6a5cb.pdf2016-09-01T11:23:202019-03-21T11:23:2010.5812/atr.33705Trauma patientsMissed InjuriesAbuseIntentional AsphyxiaAnnelieke MK.Harmsentrue1Department of Trauma Surgery, VU University Medical Centre, Amsterdam, The NetherlandsDepartment of Trauma Surgery, VU University Medical Centre, Amsterdam, The NetherlandsDepartment of Trauma Surgery, VU University Medical Centre, Amsterdam, The NetherlandsLEAD_AUTHORUdo JL.Reijnderstrue2Department of Forensic Medicine, Public Health Service, Amsterdam, The NetherlandsDepartment of Forensic Medicine, Public Health Service, Amsterdam, The NetherlandsDepartment of Forensic Medicine, Public Health Service, Amsterdam, The NetherlandsAUTHORGeorgios F.Giannakopoulostrue3Department of Trauma Surgery, VU University Medical Centre, Amsterdam, The NetherlandsDepartment of Trauma Surgery, VU University Medical Centre, Amsterdam, The NetherlandsDepartment of Trauma Surgery, VU University Medical Centre, Amsterdam, The NetherlandsAUTHORORIGINAL_ARTICLEEvaluation of Metallo-β-Lactamase-Production and Carriage of bla-VIM Genes in Pseudomonas aeruginosa Isolated from Burn Wound Infections in IsfahanBackground
Metallo-β-lactamase-production among Gram-negative bacteria, including Pseudomonas aeruginosa, has become a challenge for treatment of infections due to these resistant bacteria.
Objectives
The aim of the current study was to evaluate the metallo-β-lactamase-production and carriage of bla-VIM genes among carbapenem-resistant P. aeruginosa isolated from burn wound infections.
Patients and Methods
A cross-sectional study was conducted from September 2014 to July 2015. One hundred and fifty P. aeruginosa isolates were recovered from 600 patients with burn wound infections treated at Imam-Musa-Kazem Hospital in Isfahan city, Iran. Carbapenem-resistant P. aeruginosa isolates were screened by disk diffusion using CLSI guidelines. Metallo-β-lactamase-producing P. aeruginosa isolates were identified using an imipenem-EDTA double disk synergy test (EDTA-IMP DDST). For detection of MBL genes including bla-VIM-1 and bla-VIM-2, polymerase chain reaction (PCR) methods and sequencing were used.
Results
Among the 150 P. aeruginosa isolates, 144 (96%) were resistant to imipenem by the disk diffusion method, all of which were identified as metallo-β-lactamase-producing P. aeruginosa isolates by EDTA-IMP DDST. Twenty-seven (18%) and 8 (5.5%) MBL-producing P. aeruginosa isolates harbored bla-VIM-1 and bla-VIM-2 genes, respectively.
Conclusions
Our findings showed a high occurrence of metallo-β-lactamase production among P. aeruginosa isolates in burn patient infections in our region. Also, there are P. aeruginosa isolates carrying the bla-VIM-1 and bla-VIM-2 genes in Isfahan province.http://archtrauma.kaums.ac.ir/article_62281_fcb8c1faffc00ecd92773cc377a8e86b.pdf2016-09-01T11:23:202019-03-21T11:23:2010.5812/atr.34343Burn patientsMetallo-β-LactamaseMahmoodSaffaritrue1Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR IranTrauma Research Center, Kashan University of Medical Sciences, Kashan, IR IranTrauma Research Center, Kashan University of Medical Sciences, Kashan, IR IranAUTHORFarzanehFiroozehtrue2Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, Kashan, IR IranDepartment of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, Kashan, IR IranDepartment of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, Kashan, IR IranLEAD_AUTHORMohammadPourbabaeetrue3Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, Kashan, IR IranDepartment of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, Kashan, IR IranDepartment of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, Kashan, IR IranAUTHORMohammadZibaeitrue4Department of Parasitology and Mycology, School of Medicine, Alborz University of Medical Sciences, Karaj, IR IranDepartment of Parasitology and Mycology, School of Medicine, Alborz University of Medical Sciences, Karaj, IR IranDepartment of Parasitology and Mycology, School of Medicine, Alborz University of Medical Sciences, Karaj, IR IranAUTHORORIGINAL_ARTICLELimb Lengthening Using the PRECICETM Nail System: Complications and ResultsBackground
Three types of telescopic nails are mainly used for intramedullary limb lengthening nowadays. Despite some important advantages of this new technology (e.g. controlled distraction rate, not restricted availability, possibility to perform accordion maneuvers), few articles exist on clinical results and complications after lengthening with the PRECICETM nail (Ellipse, USA).
Objectives
The aim of the current study was to describe and analyze the complications associated with lengthening with the PRECICETM nail. Are the problems preventable when using the PRECICE, related to the distraction rate control, the lengthening goals and technique and handling?
Methods
We retrospectively reviewed the charts of 9 patients operated between 2012 and 2013 with a PRECICETM nail for a leg length discrepancy (LLD). The mean age of the patients was 32 years (range, 17 - 48 years). There were 5 femoral and 4 tibial procedures. The causes of LLD were posttraumatic (n = 5) and congenital (n = 4). The mean LLD was 36.4 ± 11.4 mm. The minimum follow-ups were 2 months (average, 5 months; range, 2 - 9 months).
Results
The mean distraction rate was 0.5 ± 0.1 mm/day. We observed in 7 patients differences in achieving the lengthening goals (average, 1.6 mm; range, -20.0 - 5.0 mm). Average lengthening was 34.7 ± 10.7 mm. All patients reached normal alignment and normal joint orientation. An unintentional loss of the achieved length during the consolidation phase was noticed in patients with delayed bone healing in two cases. In the first case (loss of 20mm distraction) the nail could be redistracted and the goal length was achieved. In the second case (loss of 10mm distraction) the nail broke shortly after the diagnosis and the nail was exchanged.
Conclusions
We report of loss of achieved length after lengthening with a telescopic nail. Weight bearing before complete consolidation of the regenerate might be a risk factor for that. Thorough examination of the limb length and careful evaluation of the radiographs are required in the follow-up period. The PRECICE nail system requires the same vigilance like the other intramedullary systems too.http://archtrauma.kaums.ac.ir/article_62282_385a1620a563d748e250f5dcf482607a.pdf2016-09-01T11:23:202019-03-21T11:23:2010.5812/atr.36273Leg Length DiscrepancyFemurIntramedullary Limb LengtheningcomplicationUlrichWiebkingtrue1Department of Trauma, Medical School Hannover, Hannover, GermanyDepartment of Trauma, Medical School Hannover, Hannover, GermanyDepartment of Trauma, Medical School Hannover, Hannover, GermanyLEAD_AUTHOREmmanouilLiodakistrue2Department of Trauma, Medical School Hannover, Hannover, GermanyDepartment of Trauma, Medical School Hannover, Hannover, GermanyDepartment of Trauma, Medical School Hannover, Hannover, GermanyAUTHORMohamedKenaweytrue3Department of Orthopedic Surgery, Sohag University, Sohag, EgyptDepartment of Orthopedic Surgery, Sohag University, Sohag, EgyptDepartment of Orthopedic Surgery, Sohag University, Sohag, EgyptAUTHORChristianKrettektrue4Department of Trauma, Medical School Hannover, Hannover, GermanyDepartment of Trauma, Medical School Hannover, Hannover, GermanyDepartment of Trauma, Medical School Hannover, Hannover, GermanyAUTHORORIGINAL_ARTICLEOutcome Analysis of Intra-Articular Scapula Fracture Fixation with Distal Radius Plate: A Multicenter Prospective StudyBackground
Scapula fractures occur in approximately 1% of all fractures and constitute about 3% - 5% of all injuries of the shoulder joint.
Objectives
This study aimed to evaluate the clinical outcomes of 20 surgically treated patients with displaced glenoid fractures after stabilization with distal radius plate.
Methods
Between 2012 and 2015, at 2 centers (HMCH & SHCE) of Bhubaneswar Odisha, we stabilized 20 scapular intra-articular fractures surgically with distal radius locking plate and studied the outcome of the surgeries. The outcome of the 20 fractures was determined using the Constant and Murley score. Both shoulders were assessed and the score on the injured side was given as a percentage of that on the uninjured side.
Results
The median score was 88% (mean 65%, range 30 to 100). The median score for strength was 21/25 (mean 19, range 0 to 25) and that for pain 11/15 (mean 11, range 5 to 15). The median functional score was 16/20 (mean 15, range 0 to 20). The mean range of active abduction of the shoulder was 135° (20 to 180), the mean range of flexion 138° (20 to 180) and the mean range of external rotation 38° (0 to 100). Five patients showed excellent result; 11 patients showed good result; three patients showed fair result and one patient had poor outcome according to the Constant-Murley score. A superficial infection settled with antibiotics after operation in one patient whose score at final follow-up was 96%. In one patient, delayed healing was reported because of infection. One patient with stiffness of the shoulder at six weeks underwent manipulation under anesthesia with a follow-up score of 81%.
Conclusions
Various fixation modalities have been described in the literature, however fixation of intra-articular fracture of glenoid with distal radius locking plate for articular reconstruction in the presented series provides good functional outcome with early restoration of the range of motion of the shoulder.http://archtrauma.kaums.ac.ir/article_62283_29086957ff22ffed1a3df23a0bd0f915.pdf2016-09-01T11:23:202019-03-21T11:23:2010.5812/atr.36406Scapula FractureDistal Radius PlateTrauma GlenoidIntra Articular GlenoidIntra Articular ScapulaFall From HeightRanajitPanigrahitrue1Department of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, IndiaDepartment of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, IndiaDepartment of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, IndiaLEAD_AUTHORDivyaMadhariatrue2Department of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, IndiaDepartment of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, IndiaDepartment of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, IndiaAUTHORDibya SinghaDastrue3Department of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, IndiaDepartment of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, IndiaDepartment of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, IndiaAUTHORSaswatSamanttrue4Department of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, IndiaDepartment of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, IndiaDepartment of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, IndiaAUTHORManas RanjanBiswaltrue5Department of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, IndiaDepartment of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, IndiaDepartment of Orthopedics, Hi-Tech Medical College & Hospital, Bhubaneswar, IndiaAUTHORORIGINAL_ARTICLEClinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib FracturesBackground
Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear.
Objectives
The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma.
Methods
Retrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT chest. The CT finding of ≥ 3 additional fractures in patients with ≤ 3 rib fractures on CXR was considered clinically meaningful. Student’s t-test and chi-square analysis were used for comparison.
Results
We identified 499 patients with rib fractures: 93 (18.6%) had CXR only, 7 (1.4%) had chest CT only, and 399 (79.9%) had both CXR and chest CT. Among these 399 patients, a total of 1,969 rib fractures were identified: 1,467 (74.5%) were missed by CXR. The median number of additional fractures identified by CT was 3 (range, 4 - 15). Of 212 (53.1%) patients with a clinically meaningful increase in the number of fractures, 68 patients underwent one or more clinical interventions: 36 SICU admissions, 20 pain catheter placements, 23 epidural placements, and 3 SSRF. Additionally, 70 patients had a chest tube placed for retained hemothorax or occult pneumothorax. Overall, 138 patients (34.5%) had a change in clinical management based upon CT chest.
Conclusions
The chest X-ray missed ~75% of rib fractures seen on chest CT. Although patients with a clinical meaningful increase in the number of rib fractures were more likely to be admitted to the intensive care unit, there was no associated improvement in pulmonary outcomes.http://archtrauma.kaums.ac.ir/article_62284_1f26076f39cb782b0f208859fc6ab13b.pdf2016-09-01T11:23:202019-03-21T11:23:2010.5812/atr.37070Rib FracturesTomography X-Ray ComputeX-raysThoracic InjuriesBrandon C.Chapmantrue1Department of Surgery, University of Colorado School of Medicine, Colorado, United StatesDepartment of Surgery, University of Colorado School of Medicine, Colorado, United StatesDepartment of Surgery, University of Colorado School of Medicine, Colorado, United StatesLEAD_AUTHORDouglas M.Overbeytrue2Department of Surgery, University of Colorado School of Medicine, Colorado, United StatesDepartment of Surgery, University of Colorado School of Medicine, Colorado, United StatesDepartment of Surgery, University of Colorado School of Medicine, Colorado, United StatesAUTHORFevenTesfalidettrue3School of Medicine, University of Colorado, Colorado, United StatesSchool of Medicine, University of Colorado, Colorado, United StatesSchool of Medicine, University of Colorado, Colorado, United StatesAUTHORKristoferSchrammtrue4Department of Radiology, School of Medicine, University of Colorado, Colorado, United StatesDepartment of Radiology, School of Medicine, University of Colorado, Colorado, United StatesDepartment of Radiology, School of Medicine, University of Colorado, Colorado, United StatesAUTHORRobert T.Stovalltrue5Department of Surgery, Denver Health Medical Center, Colorado, United StatesDepartment of Surgery, Denver Health Medical Center, Colorado, United StatesDepartment of Surgery, Denver Health Medical Center, Colorado, United StatesAUTHORAndrewFrenchtrue6Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, United StatesDepartment of Emergency Medicine, Denver Health Medical Center, Denver, CO, United StatesDepartment of Emergency Medicine, Denver Health Medical Center, Denver, CO, United StatesAUTHORJeffrey L.Johnsontrue7Department of Surgery, Denver Health Medical Center, Colorado, United StatesDepartment of Surgery, Denver Health Medical Center, Colorado, United StatesDepartment of Surgery, Denver Health Medical Center, Colorado, United StatesAUTHORClay C.Burlewtrue8Department of Surgery, Denver Health Medical Center, Colorado, United StatesDepartment of Surgery, Denver Health Medical Center, Colorado, United StatesDepartment of Surgery, Denver Health Medical Center, Colorado, United StatesAUTHORCarltonBarnetttrue9Department of Surgery, Denver Health Medical Center, Colorado, United StatesDepartment of Surgery, Denver Health Medical Center, Colorado, United StatesDepartment of Surgery, Denver Health Medical Center, Colorado, United StatesAUTHORErnest E.Mooretrue10Department of Surgery, Denver Health Medical Center, Colorado, United StatesDepartment of Surgery, Denver Health Medical Center, Colorado, United StatesDepartment of Surgery, Denver Health Medical Center, Colorado, United StatesAUTHORFredric M.Pieraccitrue11Department of Surgery, Denver Health Medical Center, Colorado, United StatesDepartment of Surgery, Denver Health Medical Center, Colorado, United StatesDepartment of Surgery, Denver Health Medical Center, Colorado, United StatesAUTHORORIGINAL_ARTICLEThe Current Perspectives of Stem Cell Therapy in Orthopedic SurgeryContext
Musculoskeletal injuries may be painful, troublesome, life limiting and also one of the global health problems. There has been considerable amount of interest during the past two decades to stem cells and tissue engineering techniques in orthopedic surgery, especially to manage special and compulsive injuries within the musculoskeletal system.
Evidence Acquisition
The aim of this study was to present a literature review regarding the most recent progress in stem cell procedures and current indications in orthopedics clinical care practice. The Medline and PubMed library databases were searched for the articles related with stem cell procedures in the field of orthopedic surgery and additionally the reference list of each article was also included to provide a comprehensive evaluation.
Results
Various sources of stem cells have been studied for orthopedics clinical care practice. Stem cell therapy has successfully used for major orthopedic procedures in terms of bone-joint injuries (fractures-bone defects, nonunion, and spinal injuries), osteoarthritis-cartilage defects, ligament-tendon injuries, femoral head osteonecrosis and osteogenesis imperfecta. Stem cells have also used in bone tissue engineering in combining with the scaffolds and provided faster and better healing of tissues.
Conclusions
Large amounts of preclinical studies have been made of stem cells and there is an increasing interest to perform these studies within the human population but preclinical studies are insufficient; therefore, much more and efficient studies should be conducted to evaluate the efficacy and safety of stem cells.http://archtrauma.kaums.ac.ir/article_62285_289b6c0b4c17bd1c934a769b7ac3d2a1.pdf2016-09-01T11:23:202019-03-21T11:23:2010.5812/atr.37976stem cellsOrthopedic SurgeryMesenchymal Stem CellsAdipose Derived Stem CellsBone Marrow Derived Stem CellsSerkanAkpancartrue1Department of Orthopedic Surgery, Gulhane Military Hospital, Ankara, TurkeyDepartment of Orthopedic Surgery, Gulhane Military Hospital, Ankara, TurkeyDepartment of Orthopedic Surgery, Gulhane Military Hospital, Ankara, TurkeyLEAD_AUTHOROnerTatartrue2Department of Orthopedic Surgery, Air Force Academy Kasımpaşa Military Hospital, Istanbul, TurkeyDepartment of Orthopedic Surgery, Air Force Academy Kasımpaşa Military Hospital, Istanbul, TurkeyDepartment of Orthopedic Surgery, Air Force Academy Kasımpaşa Military Hospital, Istanbul, TurkeyAUTHORHasanTurguttrue3Department of Orthopedic Surgery, Bursa Military Hospital, Bursa, TurkeyDepartment of Orthopedic Surgery, Bursa Military Hospital, Bursa, TurkeyDepartment of Orthopedic Surgery, Bursa Military Hospital, Bursa, TurkeyAUTHORFarukAkyildiztrue4Department of Orthopedic Surgery, Gulhane Military Hospital, Ankara, TurkeyDepartment of Orthopedic Surgery, Gulhane Military Hospital, Ankara, TurkeyDepartment of Orthopedic Surgery, Gulhane Military Hospital, Ankara, TurkeyAUTHORSafakEkincitrue5Department of Orthopedic Surgery, Agri Military Hospital, Agri, TurkeyDepartment of Orthopedic Surgery, Agri Military Hospital, Agri, TurkeyDepartment of Orthopedic Surgery, Agri Military Hospital, Agri, TurkeyAUTHORORIGINAL_ARTICLECommotio Cordis and Contusio Cordis: Possible Causes of Trauma-Related Cardiac Deathhttp://archtrauma.kaums.ac.ir/article_62286_7b9cd0a86315567828d4d45dc961eabc.pdf2016-09-01T11:23:202019-03-21T11:23:2010.5812/atr.41482Commotio CordisContusio CordisDeathAli RezaFarrokhiantrue1Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR IranTrauma Research Center, Kashan University of Medical Sciences, Kashan, IR IranTrauma Research Center, Kashan University of Medical Sciences, Kashan, IR IranLEAD_AUTHOR